what help and support there is for pregnant women with mental
health problems.

How can my mental health be affected by
pregnancy?

Many women have good mental health during
pregnancy. Some women may already have a mental illness when they
get pregnant. Others worry about mental health problems they have
had in the past. They fear getting ill again during pregnancy or
after childbirth. Some women have mental health problems for the
first time in pregnancy. Unfortunately, pregnancy does not stop
people from having mental health problems. Women who stop
medication when they get pregnant have a high risk of getting
ill again (e.g. 7 out of every 10 women who stop antidepressants in early
pregnancy become unwell again).

Depression and anxiety are the most
common mental health problems in pregnancy. These affect about 10
to 15 out of every 100 pregnant women. Women also experience many
other mental health problems during pregnancy, just like at other
times.

How your mental health is affected during
pregnancy depends on many things. These include:

the type of mental illness you have experienced

whether you are on treatment

recent stressful events in your life (such as a death in
the family or a relationship ending)

how you feel about your pregnancy. You may or may not be happy
about being pregnant. You may have upsetting memories about
difficulties in your own childhood.

Symptoms of mental illness in pregnancy are
similar to symptoms you have at other times. Some symptoms
might focus on the pregnancy. For instance, you may have anxious or
negative thoughts about your pregnancy or your baby. You may find
changes in your weight and shape difficult, particularly if you
have had an eating
disorder.

Sometimes pregnancy-related-symptoms can be
confused with symptoms of mental illness. For example, broken sleep
and lack of energy are common in both pregnancy and depression.

Some people find it more difficult than others
to cope with the changes and uncertainties which pregnancy brings.
For some women, it can be a very happy and exciting time. Others
may have mixed, or negative, feelings about being pregnant.

Many women worry about how they will cope with
having a baby. Worries about some of the following are common
when you are pregnant:

changes in your role (becoming a mother, stopping work)

changes in your relationships

whether you will be a good parent

fear that there will be problems with the pregnancy or the
baby

fear of childbirth

lack of support and being alone.

What if I have had mental health problems in the past, but am
well now?

You should be referred to a mental health
service if you are pregnant and have ever had:

It is important to get specialist advice
even if you are well during this pregnancy. Women who have had
these illnesses have a high risk of becoming unwell after
childbirth. Mental health professionals will discuss care and
treatment choices with you. They will help you make a plan for your
care, with your midwife, obstetrician, health visitor and GP.

Talk to your GP if you have had any other
mental health problems. Often your GP will be able to advise about
care and treatment. This will depend on the illness you have had
and how severe it has been.

What treatment is available for mental health problems
during pregnancy?

The best treatment for you will depend on the
type and severity of illness you have experienced. Both
medication and psychological therapies (talking treatments) can
help.

Medication

It is important to discuss medication with
your GP or psychiatrist. They will give you the information
you need to help you decide what is best for you and your baby. You
may decide to continue, change or stop your medication.

If possible, you should talk to your doctor
before you become pregnant. However, many pregnancies are
unplanned. In that case, you should see your doctor as soon
as you know you are pregnant. It is very important that you don’t
stop your medication suddenly, unless your doctor tells you to.
Stopping treatment suddenly can cause people to relapse more
quickly. It can also cause side-effects. It may be best for you to
continue medication during pregnancy.

Some medications have been used in pregnancy
for many years. A few medications are known to cause problems in
some babies if taken in pregnancy. In many cases, we simply do not
have enough information to be absolutely sure that a treatment is
safe.

Your doctor can help you to think carefully
about the advantages and disadvantages of choosing a particular
medication. In order to make this decision, you will need to think
about:

How unwell you have been in the past

How quickly you become unwell when you stop medication

Medications you have taken:

which treatments have helped you most?

have some medicines caused side-effects?

Up-to-date information about the safety of certain medications
in pregnancy.

What might happen if you are unwell during pregnancy. This
includes:

you may not take good care of yourself.

you might not attend appointments with your midwife. This means
you may not get the care you need.

people who use drugs and alcohol may use more when unwell. This
can be harmful for your unborn baby.

you may need a higher dose of medication if you become ill.
Sometimes you may need two or more medications to treat a relapse.
This might be more risky for your unborn baby than if you take a
standard dose of medication throughout pregnancy.

you may need in-patient treatment.

you may still be unwell when your baby is born. You may then
find it more difficult to care for your baby. It may also affect
your relationship with your baby.

if your illness is not treated, this may be more harmful for
your baby than the effect of medication. Untreated mental illness
may cause a number of problems. For example, some research studies
have found babies are more likely to have low birthweight if their
mother has depression in pregnancy. Untreated mental illness can
also affect a baby’s development later on.

Psychological therapies

A talking treatment may be helpful for your
mental health problem. For some women this can be used instead of
medication. Others may need a talking treatment as well as
medication.

Some psychological therapies services will see
you more quickly if you are pregnant. Your doctor can advise you
about referral in your local area.

Which professionals and services will I need to see during my
pregnancy and how can they help me?

A number of services and professionals offer
help and support during pregnancy.

Maternity services

Your midwife will ask questions about your
physical and mental health. You should tell your midwife if you
have had mental health problems. She can ensure you get the care
and support you need.

It is important that you attend your antenatal
appointments during pregnancy. In some areas midwives can visit you
at home.

Your GP

You should talk to your GP if you are worried
about mental health problems in pregnancy. Your GP can provide
information, advice and treatment. He/she can refer you to a mental
health or psychological therapies service if needed

If you are already under the care of a
CMHT, you should
tell your care co-ordinator that you are pregnant. She/he can tell
you about treatment and support available for pregnant women,
and new mothers, in your area.

If you are not under the care of a CMHT, but
have been in the past, you should talk to your GP. You may need the
support of the CMHT during pregnancy and for a few months after
birth. This will depend on the type of illness you have had.

In some areas, there are specialist mental
health services for pregnant and postnatal women. These are
called Perinatal Mental Health Services. Often these teams work
jointly with CMHTs. Your GP and midwife can tell you whether this
type of service is available in your area.

Children and Families Social
Services

In some cases your doctor, midwife or another
professional may want to refer you to Children and Families Social
Services.

Social workers from Children and Families
Social Services focus on children’s wellbeing. They provide a range
of care and support for children and families. This depends on the
needs of the child and other family members. The professional who
wants to refer you will discuss the reasons for this with you.

Your health
visitor

Health visitors see all women with new babies.
They offer advice and help about the baby’s health, feeding, sleep
and other issues. In some areas health visitors may see you even
before your baby is born.

Working together and pre-birth planning
meetings

There are usually several professionals
involved in your care during pregnancy. They need to work together
with you and your family to make sure you have the care and support
you need.

If you have had a severe mental illness, it is
helpful to have a meeting to plan your care during pregnancy. This
meeting will include you, your partner and all the professionals
involved in your care. You may also want to bring other close
family members or friends.

The meeting helps everyone agree a plan for
your care during pregnancy, delivery, and for the first few months
after birth. This plan will be written down and you should have a
copy.

Will anyone else be able to help or support me during
pregnancy?

Some people have more support than others.
Your main support may be your partner, family or friends. It is
helpful if the people closest to you know about your mental health
problems. If you are at risk of becoming unwell, they should know
what symptoms to look out for. They also need to know who to
contact for help if they are worried about you. Your partner,
family and friends can also help in practical ways - with cooking
and cleaning for instance.

Many other sources of help and support are
available for pregnant women and new mothers. This will vary
depending on where you live. Your midwife and health visitor should
be able to tell you what is available in your area. There is a list
of helpful organizations at the end of this leaflet.

What else can I do to maintain my mental wellbeing during
pregnancy?

Eat a healthy, balanced diet.

Reduce your alcohol intake. You should stop drinking if
possible. Otherwise you should not drink more than 1-2 units, once
or twice a week.

Stop smoking (ask your midwife or GP about 'stop smoking'
services).

Find some time each week to do something which you enjoy,
improves your mood or helps you to relax.

Let family and friends help you with housework, shopping
etc.

Exercise (ask your midwife about exercise in pregnancy and
local exercise classes).

Discuss any worries you may have with your family, your midwife
or GP.

Support and practical help for families
affected by mental illness. Includes 'Newpin' services
- offering support to parents of children under 5 whose mental
health is affecting their ability to provide safe
parenting.

Ask your midwife for details of your local
Children’s Centre. Sure Start Children's Centres support children
under the age of five and their families. They provide advice and
support for parents. There are often parenting classes, drop-in
sessions, outreach services, early education and childcare, and
links to training and employment opportunities.

Helpline: 08457 90 90 90; (Ireland): 1850 60
90 90; e-mail: jo@samaritans.org. National
organisation offering support to those in distress who feel
suicidal or despairing and need someone to talk to. The telephone
number of your local branch can be found in the telephone
directory.